Caring for parents from afar

Firms emerge to assist adults in arranging help

March 17, 2008|By Jonathan Peterson Los Angeles Times

"I had the feeling that all wasn't well with my father," Claire Milne recalled.

It was Christmastime in 2003, and Milne had flown from her London home to visit her 82-year-old father in Maryland. Milne noticed that her dad struggled to stay upright as he walked, early signs of a mysterious neurological condition.

Over the next four years, Milne, 56, would travel across the Atlantic every few months to watch over him, standing by during hospital stays, offering support to her ailing stepmother as well.

She helped arrange electronic payment of their bills. She helped them think through the pros and cons of moving into an apartment. She made sure her siblings were up to date on the latest health news.

"I don't think of it as a duty," Milne, a telecommunications consultant, explained shortly before her father died last year. "I think of it as what I want to do."

Like Milne, millions of adult children now find themselves faced with the challenge of caring from a distance. Americans over 85 are the fastest-growing segment of the population, according to the National Institute on Aging.

An industry of care coordinators is emerging to bridge the gap between far-off relatives and aging parents who may be overwhelmed by the labyrinth of medical and other services designed to help the aged and infirm survive in their homes.

Even now, "we don't have enough geriatric case managers to go around," said Cheri Lattimer, executive director of the Case Management Society of America, a group composed largely of health-care professionals.

As many as 200,000 workers, including nurses, social workers and family therapists, may be devoting at least some of their efforts to helping families confront a maze of support services, she said.

Care managers typically assess a troubled situation, then make referrals or help arrange needed services, including personal care or professional guidance.

Such coordinators may continue to monitor a household, serving as "eyes and ears" for far-flung family members.

Bunni Dybnis, director of professional services at LivHome Inc., a Los Angeles-based company that coordinates care for struggling seniors, said it is often during a holiday visit or other infrequent trips home that an adult child notices an unsettling change.

Packets of prescriptions lie unopened on the counter. A once-immaculate house is unkempt. A cool-headed individual is suddenly given to erratic mood swings.

For relatives, that may be when life becomes more complicated. About 7 million family members in the United States regularly travel at least an hour to assist ailing relatives with transportation, errands, help around the house and other tasks, according to AARP.

Scattered family members also may rely on the local care-coordinator industry to help with arrangements they can't handle from afar.

"I thought about moving back to Los Angeles, but it's very difficult when you've made your career somewhere else," said Evelyn Kahan, 61, a teacher near Monterey, Calif. Kahan's 86-year-old mother started having memory problems four years ago.

Instead, Kahan hired a local care manager to help her mother remain in the home she had occupied for half a century. The manager found a driver to take Kahan's mother on errands, as well as in-home aides to provide basic assistance in such areas as bathing and "to make sure she has a couple of decent meals a day."

Care managers say they help contend with a plethora of care choices or put together the support that will enable the struggling older person to live in safety and independence.

"Even physicians come to us for resources for their own parents," said Mary Winners, who founded About Senior Solutions in Monrovia, Calif. Winners, whose background is in health-care business development, employs licensed clinical social workers and psychotherapists to evaluate clients' needs.

Dybnis of LivHome has helped out-of-towners contending with a parent's mental breakdown, siblings fighting over who should provide help, and seniors mistreated by in-home aides.

"You like to believe your parents are the same as they always were," said Dybnis, a licensed marriage and family therapist whose firm has 19 sites in four states. "Everybody is in denial until something happens."

Care coordinators vary in quality and qualifications, experts caution. Costs may exceed the reach of some households, and regulation is lax.

Nonetheless, an attorney who works on elder-abuse issues said the emergence of care management as a specialty is a promising development, and coordinators could help steer families toward safe assistance and away from shady operators who offer cheap in-home care.

Cost may be an issue for some families. Private coordinators may charge $75 to $250 an hour, depending on where a client lives. In addition, some may charge more for an initial home visit.